The influence of pulmonary function testing on the management of asthma in children

OBJECTIVE: To assess how often in a single encounter that pulmonary function tests (PFTs) influenced management decisions in children with asthma, beyond what was obtained from history and physical examination alone. STUDY DESIGN: Children with asthma (n = 367, age 4 to 18 years) performed spirometry before clinical evaluation. Physicians and nurse practitioners in the outpatient pulmonary office evaluated the children and made initial treatment recommendations before reviewing the spirometry results. Any changes based on the test results were documented. RESULTS: Spirometry was abnormal in 45% of the visits, related to underlying asthma severity but not to clinical findings. PFT results changed management decisions in 15% of visits. This frequency was not affected by the patient's age, disease severity, symptom control, or exam findings. When spirometry did not change treatment decisions, the provider was more likely to maintain therapy (58%) than to increase (17%) or decrease (24%) therapy. In contrast, when spirometry did change treatment decisions, the provider was more likely to increase therapy (75%) than to maintain (20%) or decrease (5%) therapy. CONCLUSION: Without PFTs, providers often overestimated the degree of asthma control. This incorrect assessment could have resulted in suboptimal therapy.     

《周易》与《千金》二方

《周易》与《千金》二方法在思维方式、认知特征、价值观念、理论建构和范畴体系呈现出惊人的一致。说明这二者既是有亲密的地缘关系，又有深刻的继承关系。它们之间既有着文化基因的传递，价值取向的一致；又有着思维方法和认知方式的相似构建，充满着认识上和实践上的智慧。     

Urinary eosinophil protein X in children with atopic asthma: A useful marker of antiinflammatory treatment

BACKGROUND: Bronchial asthma is associated with elevated serum levels of eosinophil products, such as eosinophil protein X (EPX), but the occurrence in urine of this substance in patients with asthma has not previously been studied. OBJECTIVE: This study was performed to clarify whether increased amounts of eosinophil granulocyte proteins in urine and serum reflect ongoing asthmatic inflammation and whether decreasing values reflect successful treatment. METHODS: Twelve children with a median age of 12.5 years who had mild or moderate atopic asthma were studied for 3 months. At the time of inclusion in the study, treatment with inhaled budesonide was initiated. Nine children of the same age without atopic disease served as control subjects. Levels of EPX, eosinophil cationic protein (ECP), and myeloperoxidase in serum and in urine (urinary EPX) were determined at inclusion and then after 3 months of treatment. Spirometry was performed on the same occasions. RESULTS: At the time of inclusion, urinary EPX and serum ECP were significantly higher in children with atopic asthma than in the control subjects (mean, 116.4 vs 43.0 μg/mmol creatinine [p = 0.004] and 37.0 vs 14.8 μg/L [p = 0.004]). In the asthma group urinary EPX, as well as serum ECP, decreased significantly after 3 months of treatment with budesonide (116.4 to 68.4 μg/mmol creatinine [p = 0.005] and 37.0 to 24.0 μg/L [p = 0.04]). At the same time, peak expiratory flow values increased significantly in the children with asthma (76.0% to 87.8% of predicted value [p = 0.005]) but not in the control subjects (87.0% to 90.1%). In the asthma group the levels of myeloperoxidase were similar to those in the control group, both at inclusion and after 3 months. CONCLUSION: Increased urinary EPX and serum ECP levels seem to reflect active atopic asthma, whereas decreased levels after antiinflammatory treatment probably reflect normalization of airway inflammation, and indirectly, improved lung function. (J Allergy Clin Immunol 1996;97:1179-87.)     

Comparative efficacy and safety of low-dose fluticasone propionate and montelukast in children with persistent asthma

OBJECTIVE: To evaluate efficacy, safety, health outcomes, and cost-effectiveness of fluticasone propionate (FP) versus montelukast (MON) in 342 children (6 to 12 years of age) with persistent asthma. STUDY DESIGN: Randomized, double-blind, 12-week study of treatment with FP inhalation powder 50 mug twice daily or MON chewable 5 mg once daily for 12 weeks. RESULTS: Compared with MON, FP significantly increased mean percent change from baseline FEV1 (forced expiratory volume in 1 second) (P=.002), morning PEF (peak expiratory flow) (P=.004), evening PEF (P=.020), and percent rescue-free days (P=.002) at end point, and it significantly reduced nighttime symptom scores (P <.001) and mean total (P=.018), and nighttime (P <.001) albuterol use. Withdrawals from the study were more frequent with MON (21%) than with FP (13%). Adverse events (69% vs 71%) and mean end point to baseline 12-hour urinary cortisol excretion ratios were similar. Parents and physicians were more satisfied with FP treatment than with MON (P=.006 and P=.016, respectively, at Week 12). Mean total daily asthma-related cost per patient in the FP group was approximately one-third of that in the MON group ($1.25 vs $3.49). CONCLUSION: FP was significantly more effective than MON in improving pulmonary function, asthma symptoms, and rescue albuterol use. Both therapies had similar safety profiles. Parent- and physician-reported satisfaction ratings were higher with FP treatment, and asthma-related costs were lower.     

支气管哮喘诱导痰嗜酸性粒细胞阳离子蛋白与最大呼吸流速关系的研究

目的 分析支哮喘急性发作期（中度）患者治疗前后最大呼吸流速与诱导痰ECP浓度变化关系,以及急性发作期诱导痰ECP浓度与PEF（%）的相关性,为指导支气管哮喘的治疗提供敏感指标,为进一步评估哮喘病情、支气管哮喘治疗的疗效提供价值更好的指标.方法 选取2012年3月～2013年3月在我院就诊的确诊为支气管哮喘急性期（中度）的患者60例,经沙美特罗替卡松治疗3个月前后进行肺功能PEF测定及诱导痰ECP浓度测定.结果 哮喘患者急性发作期治疗后较治疗前增加（P＜0.05）;哮喘患者急性发作期治疗后较治疗前ECP浓度水平降低;哮喘急性发作ECP浓度与PEF（%）者有相关性（r=-0.813,P＜0.01）,呈负相关.结论 根据ECP浓度变化能评估哮喘患者的治疗疗效以及联合使用ECP、PEF%对支气管哮喘患者的病情程度进行评估及对治疗疗效进行判定及跟踪.     

中西医结合治疗支气管哮喘患者临床观察

目的观察小青龙汤治疗支气管哮喘患者的临床疗效。方法将84例支气管哮喘急性发作期患者随机分为对照组与治疗组,各42例。予对照组患者氧疗、化痰、解痉、控制呼吸道感染等西医治疗;治疗组在对照组治疗的基础上,予患者小青龙汤口服。两组疗程均为2周。观察、比较两组患者治疗前后的症状、体征、肺功能等相关指标。结果治疗结束后,治疗组总有效率为100%,对照组总有效率为92.28%,两组比较差异有统计学意义(P0.05)。两组主要症状积分、肺功能均有改善,且治疗组优于对照组(P0.05)。结论小青龙汤可以有效改善支气管哮喘患者的症状和体征,改善患者肺功能。     

探讨急性鼻窦炎对呼吸功能的影响

目的评估急性鼻窦炎对肺功能的影响。方法本研究纳入了75例成年急性鼻窦炎患者,所有患者均无任何慢性肺部疾病或过敏症状。肺功能通过肺活量测量进行评估,肺活量的测试在急性鼻窦炎首次就诊时和8周后鼻窦炎好转时进行。结果8周后患者就诊时的最大中期呼气流量（MMFR）和呼气峰流量（PEF）较首次就诊时显著增加（P〈0．05）。C反应蛋白（CRP）水平和MMFR之间存在显著相关性（r=-0．66,P〈0．05）,MMFR和PEF之间存在显著相关性（r=0．76,P〈0．05）。结论没有任何慢性肺病或过敏史的成人急性鼻窦炎患者伴随暂时的显著的最大中期呼气流量和呼气峰流量的减少。     

小青龙颗粒联合孟鲁司特钠治疗小儿支气管哮喘的临床研究

目的探讨小青龙颗粒联合孟鲁司特钠治疗小儿支气管哮喘的临床效果。方法选取2017年1月—2019年1月阿坝藏族羌族自治州人民医院收治的86例支气管哮喘患儿,使用随机数字表法随机分成对照组和治疗组,每组各43例。对照组口服孟鲁司特钠咀嚼片,4～5岁,4 mg/次,1次/d;6～12岁,5 mg/次,1次/d;睡前服用。治疗组在对照组基础上口服小青龙颗粒,4～6岁,6 g/次,3次/d;7～12岁,13 g/次,3次/d;开水冲服。两组均连续治疗4周。观察两组的临床疗效,比较两组哮喘症状评分、儿童哮喘控制测试(C-ACT)、呼气峰流速(PEF)昼夜变异率、EOS百分比(EOS%)和血清学指标比较。结果治疗后,对照组和治疗组的总有效率分别是76.7%、93.0%,两组比较差异具有统计学意义(P0.05)。治疗后,两组哮喘日间和夜间症状评分均较治疗前显著降低,而C-ACT评分显著升高,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组哮喘日间和夜间症状评分显著低于对照组,而C-ACT评分高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组第1秒用力呼气容积(FEV1)、PEF、FEV1与用力肺活量(FVC)比值(FEV1/FVC)值均较治疗前显著增高,而PEF昼夜变异率均显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组FEV1、PEF、FEV1/FVC值显著高于对照组,而PEF昼夜变异率低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组外周血嗜酸性粒细胞百分比(EOS%)及血清白介素-17(IL-17)、转化生长因子-β1(TGF-β1)、白三烯B4(LTB_4)水平较治疗前均显著下降,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组外周血EOS%及血清IL-17、TGF-β1、LTB_4水平显著低于对照组,两组比较差异具有统计学意义(P0.05)。结论小青龙颗粒联合孟鲁司特钠治疗小儿支气管哮喘具有较好的临床疗效,能有效减轻患儿症状,提高哮喘控制水平,保护肺功能,抑制机体炎症反应,具有一定的临床推广应用价值。     

止喘灵口服液联合丙酸氟替卡松治疗儿童哮喘的临床研究

目的探讨止喘灵口服液联合丙酸氟替卡松治疗儿童哮喘的临床疗效。方法选择2018年2月—2019年2月在延安市人民医院治疗的哮喘患儿86例,根据用药的差别分为对照组(43例)和治疗组(43例)。对照组吸入丙酸氟替卡松吸入气雾剂,125μg/次,2次/d;治疗组在对照组基础上口服止喘灵口服液,10 mL/次,3次/d。两组均治疗1周。观察两组患者临床疗效,同时比较治疗前后两组患者症候积分,LCQ、PAQLQ、C-ACT和MARS-A评分,最大呼气流量(PEF)、用力肺活量(FVC)和一秒用力呼气容积(FEV1)值,及血清金属蛋白酶抑制因子1(TIMP1)、细胞间粘附分子-1(ICAM-1)、半胱氨酰白三烯(CysLTs)、降钙素原(PCT)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平。结果治疗后,对照组临床有效率为81.40%,显著低于治疗组的97.67%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者喘息、咳嗽、咳痰及肺部啰音等症候积分均明显下降(P0.05),且治疗组症候积分明显低于对照组(P0.05)。治疗后,两组LCQ、PAQLQ、C-ACT和MARS-A评分均明显升高(P0.05),且治疗组这些评分明显高于对照组(P0.05)。治疗后,两组FEV1、FVC、PEF均明显升高(P0.05),且治疗组FEV1、FVC、PEF明显高于对照组(P0.05)。治疗后,两组血清TIMP-1、ICAM-1、CysLTs、PCT、IL-6、TNF-α水平均显著下降(P0.05),且治疗组血清TIMP-1、ICAM-1、CysLTs、PCT、IL-6、TNF-α水平明显低于对照组(P0.05)。结论止喘灵口服液联合丙酸氟替卡松吸入气雾剂治疗儿童哮喘可有效改善患儿临床症状,促进肺功能改善,提高生活质量,改善机体细胞因子水平,提高免疫。